Mitsugu Kawanami

Churg–Strauss syndrome with pachymeningitis refractory to steroid therapy atone – a case report

Churg-Strauss syndrome (CSS) is a rare syndrome of unknown cause, which is characterized by bronchial asthma and hypereosinophilia followed by systemic symptoms of angiitis. In 1951, Churg and Strauss first distinguished this disease from periarteritis nodosa. Our patient in particular was also complicated with otorhinological symptoms, which have less frequently been reported in CSS cases. We have detailed her clinical symptoms.

Proliferative Myositis of Sternocleidomastoid Muscle; A Case Report.

A 40-year-old man had noted left upper neck swelling for 20 days. A 6 x 6 cm smooth, hard, fixed mass was palpable on the left side of the upper neck. CT scan did not show a clear boundary between the mass and the sternocleidomastoid muscle. Biopsy was performed, and the microscopic diagnosis was proliferative myositis. Therapy was conservative, and the mass disappeared completely two months after the start of the therapy. The patient is free of disease for more than one year after the therapy. Proliferative myositis is a benign self-limited lesion, so it is very important to distinguish it from malignant diseases.

Lymph node dissection in patients with advanced thyroid cancer.

The thyroid gland is rich in lymph channels, and thyroid cancer frequently metastasizes to cervical lymph nodes. There are two main lymph channels, superior and inferior, from the thyroid gland to the deep cervical lymph nodes. However, it has not yet been clarified as to whether the lymph channels run anterior or posterior to the carotid vessels.We treated three patients with advanced thyroid cancer and found that the lymph node metastases were located in a continuous chain from the thyroid gland to the inferior deep cervical lymph nodes. The lymph node metastases proceeded along the recurrent nerve, passed posterior to the common carotid artery and reached the inferior deep cervical lymph nodes.Thus, the main lymph channel from the thyroid gland to the inferior deep cervical lymph nodes seems to pass posterior to the common carotid artery. Therefore, lymph node dissection must be done thoroughly in this region.

5-FU single high dose infusion in multimodal therapy for head and neck cancer.

Twenty-five patients with cancer of the head and neck were treated with high dose 5-FU infusion alone or as part of multimodal cancer treatment program. The infusion dose was 1500mg/24 hours for 120 hours via a peripheral vein. The courses were repeated at 2-3 week intervals. The tumor response and clinical effect of 5-FU high dose chemotherapy were evaluated in 12 patients who received 5-FU infusion alone. In the 10 patients with previously untreated epidermoid cancer, tumor response was apparent in 6 (1 had complete response and 5 partial response). In 9 of the 10 epidermoid cancer patients 5-FU was clinically effective and proved to be useful in further treatment as a part of multimodal therapy. Mild leukopenia, stomatitis, diarrhea and vasculitis/pigmentation were prominent side effects, but they could be tolerated by all 25 patients, even those with far-advanced cancer. This chemotherapy could be combined with radiotherapy. The results demonstrate that 5-FU alone in high dose infusions can play a role in preoperative induction chemotherapy and in multimodal cancer therapy.

A clinical study of 71 patients with thyroid tumors.

Seventy one patients with thyroid tumors received surgical treatment in our hospital from April 1985 to March 1988. 1) The pathological diagnosis in 39 patients (55%) was benign tumor (22 adenomatous goiters, 15 follicular adenomas, 2 cysts) and in 32 patients (45%) it was malignant tumor (27 papillary carcinomas, 3 follicular carcinomas, 1 malignant lymphoma, 1 squamous cell carcinoma). 2) For the preoperative diagnosis, delayed scintigraphy with 2a1T 1 C 1 and fine needle aspiration biopsy were quite useful in differentiating malignant thyroid tumors from benign ones. 3) Intraoperative frozen sections were helpful when the preoperative diagnosis was incorrect. 4) Cervical lymph node metastases were found in 75% of the patients with papillary or follicular carcinomas. 5) When cervical lymph node metastasis was obvious clinically, radical or modified neck dissections were performed. In patients without clinically apparent metastases, local neck dissection and sampling of the internal jugular chain were performed. When microscopic metastases were found in frozen sections, appropriate neck dissections were added.

Appropriate lymph node dissection in thyroid adenocarcinoma.

Thirty-four patients underwent thyroid surgery for papillary and follicular adenocarcinomas in the period from 1985 to 1989. Fourteen patients were treated with local neck dissection and 20 patients, with modified or radical neck dissection. Cervical lymph node metastasis was found in 25 patients (74%). Our recent policy for lymph node dissection is as follows: When deep cervical lymph node metastasis is clinically demonstrated, radical or modified neck dissection is performed. In patients without clinically demonstrated metastasis, local neck dissection and sampling of the internal jugular chain are performed. When microscopic metastasis is found in frozen sections, modified neck dissection is added. Thus we could select patients for modified neck dissection and choose appropriate neck dissection for more complete cancer clearance without losing postoperative functions.